Chronic abdominal pain is a major source of morbidity for patients with chronic pancreatitis and pancreatic cancer, and effective pain management options are limited. Endoscopic ultrasound (EUS)-guided celiac plexus interventions are minimally invasive procedures designed to alleviate severe upper abdominal pain associated with these conditions, however, data reporting the effect of these interventions are scarce and based in small reports. This systematic review and meta-analysis evaluates the effectiveness and safety of EUS-guided celiac plexus interventions for managing abdominal pain in patients with chronic pancreatitis and pancreatic cancer.

A comprehensive search of OVID MEDLINE, EMBASE, and Cochrane CENTRAL was conducted from inception to September 1^st, 2025. We included full-text randomized controlled trials (RCTs) evaluating EUS-guided celiac plexus block (CPB), celiac plexus neurolysis (CPN), or celiac ganglion neurolysis (CGN) in patients with chronic pancreatitis or pancreatic cancer. The primary outcome was the proportion of patients experiencing pain relief. Secondary outcomes included duration of pain relief, reduction in opioid consumption, and adverse events. Subgroup analyses were performed based on patient diagnosis and intervention type.

Fourteen RCTs (n=596 patients) met the inclusion criteria. Four studies evaluated EUS-CPB in patients with chronic pancreatitis, and ten studies evaluated EUS-CPN or EUS-CGN in patients with pancreatic cancer. The overall pooled proportion of patients with pain relief was 70% (95% CI: 0.60-0.79), with significant heterogeneity (I²=80%). In subgroup analyses, the pooled proportion of pain relief was 73% (95% CI: 0.50-0.91) for patients with chronic pancreatitis and 68% (95% CI: 0.57-0.78) for patients with pancreatic cancer. Complete pain response was reported in five studies with a pooled proportion of complete pain response of 23% (95% CI: 0.09-0.41). The mean duration of pain relief, reported in four studies, was 89.8 days, and seven studies reported on changes in opioid consumption with a pooled reduction of opioid use by 39% (95% CI: 0.20-0.58). Unilateral versus bilateral technique for EUS-guided interventions did not have any significant differences in pain reduction. Serious adverse events were infrequent; three studies reported a total of three major events (one upper gastrointestinal bleed, one irreversible paralysis, and one hematoma). Furthermore, two studies reported that six patients required hospitalization or an emergency department visit for severe abdominal pain.

EUS-guided celiac plexus interventions are safe and provide significant pain relief for patients with abdominal pain secondary to chronic pancreatitis and pancreatic cancer. These findings support their use as a key component in a multimodal pain management strategy for this challenging patient population. However, significant heterogeneity across studies and few RCTs with small sample sizes highlights the need for larger, well-designed RCTs. Future research should focus on standardizing endoscopic techniques, identifying key predictors of response, and evaluating long-term effects on opioid consumption reduction and quality of life to better define the role of these interventions.